Psychogenic nonepileptic seizures (PNES), also known as pseusoseizures, are episodes of movement, sensation, or behaviors that are similar to epileptic seizures but are not associated with physiological central nervous system dysfunction, but rather they are somatic manifestations of psychologic distress. Therefore, psychogenic seizures are not caused by abnormal brain electrical activity. Diagnosis may be difficult due to the broad diversity of PNES presentations, lack of one single unifying presenting symptom, co-occurrence of PNES and epilepsy in the same patient, and discomfort in making a psychiatric diagnosis. PNES episodes are not “purposely” produced by the patient, and the patient is not aware that the seizures are non-epileptic.
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Therefore, confirmatory testing is required. Video-electroencephalography (EEG) is the gold standard test for the diagnosis of PNES and should be performed in all patients in whom this diagnosis is suspected. 25-40% of patients evaluated in inpatient epilepsy monitoring units for intractable seizures are diagnosed with PNES (Ettinger). The most reliable predictors of psychogenic non-epileptic seizures include at least two normal electroencephalography studies in the face of at least two seizures per week and resistance to two antiepileptic drugs (Gillins). Certain laboratory studies can help differentiate PNES from epileptic seizure, such as, prolactin levels, creatine phosphokinase (CPK), cortisol, white blood cell count, lactate dehydrogenase, pCO2, ammonia, and neuron specific …show more content…
Frontal lobe seizures often are mistaken for nonepileptic seizures because of the associated dramatic motor and vocal outbursts, possible retained consciousness, and short postictal period. Frontal lobe seizures may be distinguished by their brief duration, stereotypical nature, and tendency to begin during sleep (Barry). Gelastic seizures, reflex epilepsies, and myoclonic jerks also have been mistaken for psychogenic nonepileptic seizures (Barry). Patients require a normal Video-electroencephalography study in the presence of a typical seizure to diagnose PNES. Classic symptoms of epileptic seizures such as tongue biting, incontinence, and self-injury, are not very common in psychogenic nonepileptic seizures. Autonomic manifestations (tachycardia, cyanosis) during an ictus suggest epileptic seizure, and their absence, suggest
Therefore, confirmatory testing is required. Video-electroencephalography (EEG) is the gold standard test for the diagnosis of PNES and should be performed in all patients in whom this diagnosis is suspected. 25-40% of patients evaluated in inpatient epilepsy monitoring units for intractable seizures are diagnosed with PNES (Ettinger). The most reliable predictors of psychogenic non-epileptic seizures include at least two normal electroencephalography studies in the face of at least two seizures per week and resistance to two antiepileptic drugs (Gillins). Certain laboratory studies can help differentiate PNES from epileptic seizure, such as, prolactin levels, creatine phosphokinase (CPK), cortisol, white blood cell count, lactate dehydrogenase, pCO2, ammonia, and neuron specific …show more content…
Frontal lobe seizures often are mistaken for nonepileptic seizures because of the associated dramatic motor and vocal outbursts, possible retained consciousness, and short postictal period. Frontal lobe seizures may be distinguished by their brief duration, stereotypical nature, and tendency to begin during sleep (Barry). Gelastic seizures, reflex epilepsies, and myoclonic jerks also have been mistaken for psychogenic nonepileptic seizures (Barry). Patients require a normal Video-electroencephalography study in the presence of a typical seizure to diagnose PNES. Classic symptoms of epileptic seizures such as tongue biting, incontinence, and self-injury, are not very common in psychogenic nonepileptic seizures. Autonomic manifestations (tachycardia, cyanosis) during an ictus suggest epileptic seizure, and their absence, suggest